In HUMC Opco, LLC v. United Benefit Fund, the United States District Court for the District of New Jersey addressed motions to dismiss an ERISA action brought against a health insurer and insurance claims administrators. The action concerned medical bills in excess of $7 million, for medical care provided by a hospital over the course of nearly a year. According to the Complaint, the patient’s health insurer was obligated to pay over $789,000.00 for the medical care based upon the so-called “Medicare rate,” but instead paid less than $12,900.00. Following the patient’s death, his spouse assigned his right to benefits
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Archives for Insurance Law
New York Court Enforces Policy’s Suit Limitation Clause
The Kings County Supreme Court enforced a 12-month suit limitation clause and dismissed a wind and hailstorm claim involving damage to two apartment complexes in Dallas, Texas. In doing so, the Court enforced well-established New York authority holding that policy provisions that modify the statute of limitations by mandating that suit be brought within 12-months of any loss are reasonable and enforceable. In Chandler Management Corp. Corp. v. First Specialty Insurance Corp., the insured sought recovery under its commercial property policy for wind and storm damage to the roofs of two Dallas apartment complexes damaged during a May 24, 2011
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Colorado Supreme Court Holds That Violation of “No Voluntary Payments” Clause Precludes Coverage Regardless of Prejudice to Insurer
The Colorado Supreme Court held that a liability insurer has no obligation to indemnify a policyholder for a settlement made without the insurer’s consent and in violation of the policy’s “no voluntary payments” clause. In so doing, the Court rejected the argument that this clause is only enforceable if its violation resulted in prejudice to the insurer. In Travelers Prop. & Cas. Ins. Co. of Am. v. Stresscon, an insured subcontractor sought indemnification from its insurer for a claim made by a general contractor regarding a construction accident allegedly caused by a subcontractor of the insured. The subcontractor settled with
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New York Trial Court Applies Flood Exclusion to Superstorm Sandy Business Interruption/Food Spoilage Claim
In Northern Spy Food Co., LLC v. Tower Nat’l Ins. Co., an insured restaurant challenged its insured’s denial of a business interruption/food spoilage claim with regard to a power outage occurring during Superstorm Sandy. In denying the claims, the insurer contended that the policy’s flood exclusion applied, as the power outage was caused by extensive flooding at a power station. In analyzing coverage, the Supreme Court of New York County noted that the business interruption policy language provided coverage for a suspension in operations resulting from a “direct physical loss” that is “caused by or result[ed] from a Covered Cause
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Bad-Faith Failure-to-Settle Claims Accrues Only After Final Judgment, Delaware High Court Says
The statute of limitations for a bad-faith failure-to settle claim accrues when an insured suffers a judgment in excess of policy limits and that judgment becomes final and non-appealable, according to the Delaware Supreme Court. In Connelly v. State Farm Mut. Auto. Ins. Co., C.A. No. K14C-09-002 (March 4, 2016), the Court rejected State Farm’s contention that the bad-faith claim accrues only when the insurer allegedly acts in bad faith and breaches its duty to the insured. State Farm had provided a defense to its insured for a motor vehicle accident lawsuit. The driver offered to settle the case with
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Split NJ Supreme Court Rules That Liability Insurer Can Rescind Policy for Doctor’s Material Misrepresentation on Application
Reversing a lower court’s ruling, in DeMarco v. Stoddard the New Jersey Supreme Court held that the Rhode Island Medical Malpractice Joint Underwriting Association (“RIJUA”) did not have to provide any defense or indemnification in a medical malpractice action to a doctor who made a material misrepresentation on his application for insurance. Plaintiff attempted to argue that because medical malpractice insurance is mandatory in New Jersey and a minimum amount of $1,000,000 in coverage is required, then RIJUA should be required to cover the doctor for the statutory minimum, similar to the protection afforded innocent third parties when a motor
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New York Homeowners’ Suit Against Insurer for Mold Damage Barred by Policy’s Suit Limitations Provision
Rejecting the homeowners’ argument that the insurer was equitably estopped from asserting a statute of limitations defense, the United States District Court for the Southern District of New York recently held that the two year suit limitations provision of the insurer’s policy barred the insured’s breach of contract action, which was not filed until almost nine years after the date of loss. In granting the insurer’s Motion for Judgment on the Pleadings, the court in Clement v. Farmington Casualty Company found that the insureds failed to prove any affirmative wrongdoing by the insurer that could meet the requirements of the
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Bad Faith Count Against Insurer Dismissed by New York Court as Duplicative of Breach of Contract Cause of Action
A Nassau County trial court dismissed an insured’s bad faith counterclaim against an insurer in a declaratory judgment action on the basis that New York law does not recognize a claim for bad faith refusal to comply with an insurance contract. In Preferred Contractors Ins. Co. v. Cipco Boarding Co, Inc., the insurer moved to dismiss the insured’s bad faith counterclaim for failure to state a cause of action. While the court recognized that New York does recognize a claim for bad faith failure to settle a tort action within insurance policy limits, the court held that there is no
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New York Court Holds No Coverage for Restaurant’s Losses from Sandy Power Outage
In a case arising from business losses due to power outages caused by flooding during Superstorm Sandy, a New York trial court found that the water damage exclusion of the insurance policy unambiguously excluded coverage for power interruptions caused by flood. In La Casa di Arturo, Inc. v. Tower Group, et al., the policy provided coverage for loss associated with power interruptions that “result from direct physical loss or damage by a Covered Cause of Loss.” Water and flood were specifically excluded as covered causes of loss. Relying on the adjuster’s report and a Con Edison report—both of which concluded
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New York Insurer Can’t Avoid Defending Insured After Late Denial of BI Claim
The United States District Court of the Southern District of New York ruled that an insurer ran afoul of the timeliness requirements of New York Insurance Law § 3420(d)(2) when it disclaimed coverage 10 months after receiving notice of the claim. In Montpelier U.S. Insurance Co. v. 240 Mt. Hope Realty Co., the court held that the insurer’s late disclaimer failed to meet the law’s requirement that written notice of a denial for a bodily injury claim must be given as soon as is reasonably possible to the insured and the injured person. In addition, since the insurer had initially
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